The Postpartum Masquerade

Women who are severely ill can present well and look good. Really good.

At first glance, they can look good physically with every hair in place, and they can look good clinically, responding to our questions with deliberate precision.

Unremitting symptoms of depression might be lurking behind the camouflage that things are fine. If clinicians aren’t carefully reading between the lines at all times, they might miss that. Other times, symptoms that shriek with alarming intensity, might be a sign of a transient emotional state that has less clinical urgency.

To reconcile this apparent discrepancy, I emphasize the most basic lesson that shapes the work of a postpartum therapist:

Do not assume, if she looks good, that she is fine.

Do not underestimate the enormous power a postpartum woman achieves by maintaining the illusion of control.